Anita King iHuman

History & Physical exam – Anita King iHuman 

  • How can I help you today?
  • Do you have any other symptoms or concerns that we should discuss?
  • When did your rash start?
  • What are the events surrounding your rash?
  • Does anything make the rash better or worse?
  • Is your rash painful or itchy?

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Anita King Human  – Key Findings and Problem Statement

Case: Key findings

  • Bilateral inner thighs with 10 x 12 cm raised, confluent, erythematous papules and blisters in various stages
  • Left ventral forearm with 6 cm linear, erythematous papules, and yellow-red blisters
  • Itching progressing to tenderness
  • New exposures: Wild brush plants
  • New exposures: Hot tub
  • New exposures: Oily suntan lotion
  • New exposure: Scallops

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Case: Key findings feedback

Bilateral inner thighs with 10 x 12 cm raised, confluent, erythematous papules and blisters in various stages: The location of the original rash provides information on the manner of spread. This information, in concert with the morphology of the rash, is pivotal for determining the cause of the rash. Therefore, it is the most significant active problem (MSAP)
Left ventral forearm with 6 cm linear, erythematous papules and yellow-red blisters: This secondary location indicates the pattern of the rash’s spread. Along with its similar appearance to the original rash, this secondary rash is related to the MSAP
itching progressing to tenderness: The itchy nature of the rash along with its progression to tenderness is pivotal for deciding the order of the differential diagnosis list This finding is related to the MSAP.
New exposures: Wild brush plants: Exposure to wild plant material is a key historical element that could indicate an origin for the MSAP. Since a direct correlation is uncertain, it is unknown if this finding is related to the MSAP
New exposures: Hot tub: Hot tub water can contain bacteria (such as Pseudomonas) and chemicals that cause skin imitation or infection, so exposure to it is a key historical element that could indicate an origin for the MSAP Since a direct correlation is uncertain, it is unknown if this finding is related to the MSAP.
New exposures: Oily suntan lotion: Exposure to the chemicals, preservatives, and scents of a new lotion could indicate an origin for the MSAP. This new topical lotion can lead to skin irritation or can intensify sunlight rays in some cases. Since a direct correlation is uncertain, it is unknown if this finding is related to the MSAP
New exposures: Scallops: Exposure to new food could indicate an origin for the MSAP Since a direct correlation is uncertain, it is unknown if this finding is related to the MSAP.

Case: Problem Statement

The patient, a 25 yo otherwise healthy female, presents with 2 days of intensely pruritic erythematous papular rash on the inner thighs and left inner forearm. Recent exposures include hiking through the woods, hot tub use, new lotion use and ingesting scallops for the first time in her life. Physical examination shows a 6 cm set of linear, circumscribed, erythematous blisters on the left inner forearm and a 10 x 12 cm scattered contiguous erythematous papular rash with surrounding superficial excoriations on the inner thighs. Vitals and the remaining physical examination are unremarkable

Case: Management Plan

Pharmacologic Care:
• Apply clobetasol propionate 0.05% cream twice a day until clear
• Take OTC cetirizine 10 mg 1 tab PO daily as needed for itching
Supportive Care:
•Take oatmeal baths.
• Apply cool, wet compresses to affected areas
•Apply topical calamine lotion or aluminum acetate to affected areas.
Patient Education:
•Educated patient on the diagnosis of contact dermatitis, potential etiologies, treatment regimen, and prognosis
•Advised the patient to avoid poison ivy, oak, and sumac. Explained plant appearance.
Educated patient on medications, including indications, proper administration, side effects, and red flag symptoms for discontinuation.
• Advised patient to wash all clothing, towels, sheets, etc., in hot water to remove potentially imitant oils
Follow-Up:
Follow up in the clinic if symptoms do not start to improve within 48-72 hours
Discussed warning signs to call the clinic immediately or to go to the ER, including but not limited to difficulty breathing, increased swelling, vomiting, fever, purulent skin discharge, or other concerning symptoms Anita King iHuman